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Acta Oncol. 2017 Aug;56(8):1081-1088. doi: 10.1080/0284186X.2017.1325004. Epub 2017 May 23.

Variability in axillary lymph node delineation for breast cancer radiotherapy in presence of guidelines on a multi-institutional platform.

Author information

1
a Division of Radiation Oncology , Istituto Europeo di Oncologia , Milano , Italy.
2
b Division of Radiotherapy , Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale IRCCS , Napoli , Italy.
3
c Department of Radiation Oncology , S. Camillo-Forlanini Hospital , Roma , Italy.
4
d Department of Internal Medicine , Radiotherapy Institute, Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi , Ancona , Italy.
5
e Radiotherapy and Radiosurgery Department , Humanitas Cancer Centre and Research Hospital , Milano , Italy.
6
f Radiotherapy Unit 1 , National Cancer Institute of Milan , Milano , Italy.
7
g Radiotherapy Unit , Fondazione Poliambulanza , Brescia , Italy.
8
h Department of Radiotherapy , Campus Bio-Medico University , Roma , Italy.
9
i Radiotherapy Department , Ivrea Community Hospital , Ivrea , Italy ; Radiation Oncology Department, Tomotherapy Unit , Ospedale Regionale 'U. Parini', AUSL Valle d'Aosta , Aosta , Italy.
10
j REM Radioterapia , Istituto Oncologico del Mediterraneo (IOM) , Catania , Italy.
11
k Department of Radiation Oncology , Fondazione Salvatore Maugeri , Pavia , Italy.
12
l Radiation Oncology Section , University of Perugia and Perugia General Hospital , Perugia , Italy.
13
m Radiotherapy Unit , Azienda Sanitaria 10 , Firenze , Italy.
14
n Radiotherapy Unit , Ospedale Fatebenefratelli Isola Tiberina , Roma , Italy.
15
o Department of Radiotherapy , Azienda Sanitaria Universitaria Integrata Santa Maria della Misericordia , Udine , Italy.
16
q Department of Oncology and Hemato-oncology , University of Milan , Milano , Italy.
17
p Scientific Directorate , European Institute of Oncology , Milano , Italy.

Abstract

AIM:

To quantify the variability between radiation oncologists (ROs) when outlining axillary nodes in breast cancer.

MATERIAL AND METHODS:

For each participating center, three ROs with different levels of expertise, i.e., junior (J), senior (S) and expert (E), contoured axillary nodal levels (L1, L2, L3 and L4) on the CT images of three different patients (P) of an increasing degree of anatomical complexity (from P1 to P2 to P3), according to contouring guidelines. Consensus contours were generated using the simultaneous truth and performance level estimation (STAPLE) method.

RESULTS:

Fifteen centers and 42 ROs participated. Overall, the median Dice similarity coefficient was 0.66. Statistically significant differences were observed according to the level of expertise (better agreement for J and E, worse for S); the axillary level (better agreement for L1 and L4, worse for L3); the patient (better agreement for P1, worse for P3). Statistically significant differences in contouring were found in 18% of the inter-center comparison. Less than a half of the centers could claim to have a good agreement between the internal ROs.

CONCLUSIONS:

The overall intra-institute and inter-institute agreement was moderate. Central lymph-node levels were the most critical and variability increased as the complexity of the patient's anatomy increased. These findings might have an effect on the interpretation of results from multicenter and even mono-institute studies.

PMID:
28534430
DOI:
10.1080/0284186X.2017.1325004
[Indexed for MEDLINE]

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